Is the availability of buprenorphine/naloxone therapy for opioid-dependent inmates a necessity?

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1 Rev Esp Sanid Penit 2013; 15: Is the availability of buprenorphine/naloxone therapy for opioid-dependent inmates a necessity? A Marco 1, A López-Burgos 2, L García-Marcos 3, C Gallego 4, JJ Antón 5, A Errasti 6 Centros Penitenciarios de Hombres (Barcelona) 1, Sevilla I 2, Pereiro de Aguiar (Ourense) 3, Quatre Camins (Barcelona) 4, Albolote (Granada) 5 y Nanclares (Álava) 6. ABSTRACT Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective way to prevent relapse in opioid-dependent patients. These programs reduce morbidity and risk behaviours for HIV transmission and other infections, improve quality of life and retention in treatment, and have a positive impact on antisocial behaviour. They are therefore very useful for prisoners with a history of opiate use. OATs based on buprenorphine/naloxone (B/N), along with others using methadone, are currently available in Spain. Diversified treatment offers an alternative treatment for opioid dependence that is more personalized and tailored to the patient s characteristics. As regards effectiveness, both drugs are very similar, but B/N shows a better safety profile and fewer drug-drug interactions and can be dispensed in pharmacies once the patient is released, which can assist with the patient social reintegration. B/N treatment is more expensive than methadone. It is advisable to have different modes of OAT. These should be prescribed according to the characteristics and needs of each case, without incarceration impeding the right to drug treatment, which should be similar to that performed outside prison. Key words: Substance-Related Disorders; Opioid-Related Disorders; Opium / Agonism; Substance Abuse Treatment Centers; Buprenorphine; Naloxone; Prisons; Spain. Text received: Text accepted: INTRODUCTION The number of opiod dependent people in Spain is estimated at a total of individuals. This figure reaches people in Europe. In 2007, 50% of treatment implementation featured heroin as the main substance of abuse, and European opioid-dependent patients were subject to opioid agonist therapy (OAT) substitution programs 1. Substitutive treatment in combination with psychosocial care is the main therapeutic option for heroin consumers in Europe 2-3. After the introduction of buprenorphine in Cyprus s medication stock in 2007, this type of therapy is available in all EU Member States, as well as in Croatia and Norway. Northern and eastern European countries feature a reduced availability of these therapeutic strategies. The most commonly used agonists in substitution treatments are methadone (MT) and buprenorphine alone or in combination with naloxone (B/N). In Spain, commercial distribution of the B/N combination started in 2006, but its use is still reduced, which does not seem to be due only to the lack of experience with this therapy. The aim of this report is to assess the advantages and disadvantages of substances used in OAT, as well as to review the situation of parity between treatment in prison and therapy outside the prison realm. OAT TREATMENT It is sometimes believed that substance abuse is a manifestation of moral weakness, without taking into consideration that physiopathology of addiction is 105

2 34 Rev Esp Sanid Penit 2013; 15: affected by genetic factors which make certain individuals more prone to addiction 4. It is also usually disregarded that extended drug consumption leads to brain alterations 5 which modify the reward pathways 6 and produce an intense desire of drug consumption known as craving, consequently leading to reiteration in consumption or relapse 7-8. OAT treatment, along with psychosocial approach, is the most effective way to prevent relapse in heroin consumers OAT advantages OATs not only diminish the use of opioids and have a positive impact on patient behavior 9-10, but they also decrease morbidity and risk behavior for HIV and other infections transmission. In addition to this, they improve quality of life and treatment adherence 8, These programs are important not only from a healthcare point of view, but also from a sociopolitical one, since they contribute to reduce illegal substance abuse, delinquency and criminality 13. Opioid dependent patients feature morbidity, both from infections related to consumption, acute intoxication ( drug overdose ), and other causes such as traffic accidents associated to drug abuse. Regarding this, OATs present ideal results, especially as far as injectable drug consumption and consumption related risk behavior are concerned 15. As a matter of fact, it is estimated that opioid-dependent patients who are not subject to OAT therapy feature a risk 6 times higher of HIV infection than those who are under treatment 16. For the most part, OATs reduce opioid consumption, both injectable and non-injectable, along with the number of consumers with several sexual partners and the use of sex in exchange for drugs or money 17. Actually, decrease in endovenous drug abuse and other risk behavior patterns has led to a reduction, both in Spain and in other countries, of HIV and HCV prevalence amongst prison population, as well as amongst non-convict population OATs also help to decrease mortality rates. Regarding this, an estimate reports that patients under OAT treatment feature a rate three or four times lower than prison inmates who are not subject to this sort of treatment. On the other hand, the average yearly cost in Spain per patient under triple antiretroviral treatment was estimated at euros in , while the yearly cost per OAT patients under MT or B/N therapy was estimated at euros (MT) and euros (B/N) in Through comparison between the different treatment s yearly costs, the economical, human and 106 healthcare benefit of HIV infection prevention becomes apparent. Concerning criminality, it is commonly accepted that OATs decrease its rates, for they reduce opioid consumption, which is intimately related to recidivism In a study carried out in the UK, comparison between opioid-dependent individual s penalties two years prior to and after their specific treatment depicted that the number of penalties had been reduced by 26%. This did not depend on whether patients began their treatment willingly, as a consequence of a court warrant issued regarding the patient or as a requirement for probation 24. OATs are, therefore, also beneficial from a social point of view. It is possible that, taking only into account their impact on criminality prevention, excluding different revenue, OATs are cost-effective interventions. By means of reducing delinquency, police, court and prison costs are reduced as well In the US, a report features that for each dollar invested in treatment, the costs regarding drug-related crimes, including theft, and the court systems costs decrease 4 to 7 dollars. This figure could reach 12 dollars if healthcare cost reduction was to be taken into consideration. 2. OATs in prisons There is a significant opioid-dependent patient prevalence among prison inmate population, for it is common that illegal drug consumers commit criminal offence, especially against property 9, In Spain, the last National Drug Policy Report (PND in Spanish) 29, estimated that a total number of drug-dependent prison inmates in 89 prison facilities were subject to drug-dependence treatment: in outpatient treatment programs, in modular programs and in MT maintenance programs. Our country has attested that opioid-dependent individuals commit more frequent and serious offence than cocaine consumers The Proteus Study reports a 19% of court procedure prevalence among patients under OAT. Spain is one of the countries with the highest OAT implementation rates in prisons 32. The priority concerns of the PND Plan of Action for the period starting from 2009 until and the main aims of the National Strategy on Drugs 34 include ensuring integral attention for drug-dependent prison inmates regardless of the treatment modality. Moreover, a high percentage of prison inmates incarcerated for drug-related crime and who have not been subject to treatment during their imprisonment, lapse back into drug consumption after their release

3 Rev Esp Sanid Penit 2013; 15: This has been related to a high risk of overdose and death during the first weeks and months after release 29, OAT programs carried out in prisons reduce the risk of heroin consumption during the period immediately following discharge 36. Due to this, coordination with community OAT maintenance program services becomes extremely relevant, for it prevents treatment interruption. 3. OATs: equal access, quality and diversification both amongst the community and within prisons. OATs are provided more and more frequently in prisons. The continuity of this sort of therapy after incarceration is approved by 26 European countries but is not implemented in five of them. 21 of these countries provide treatment from the start upon arrival in prison 1. Intravenous drug consumption (UDI in Spanish) and some infections related to endovenous abuse, as well as HIV infection, are much more prevalent amongst prison inmates than amongst the community As a result of this, and especially due to the fact that incarcerated population has the same right to healthcare as the population without freedom deprivation, the same therapy modalities which are offered to opioid-dependent patients outside prison must be offered to prison inmates 39, as it has been regarded by the WHO for years 40. The EU Council of Ministers considers that healthcare within prisons must reach the same levels as healthcare provided to the community, with special emphasis on treating psychiatric disorders 41 and transmissible disease, HIV infection in particular. It has been considered that prison healthcare must rely upon a similar budget as primary healthcare aimed at the general population. Nevertheless, if we take into consideration the higher risk of suffering certain diseases, such as mental disorders and others, amongst prison inmates, this budget should probably be larger 41. The WHO even recommends that prison healthcare services work together with the national healthcare services and the Ministry of Health, in order to ensure that prisons provide the same healthcare standard as hospitals 42. Despite this fact, prison healthcare services in Spain have not been integrated, except for the basque services, into the autonomic healthcare services, causing possible service malfunction 43 and equity problems as far as healthcare resources are concerned. There are many countries which still have not implemented OAT therapy programs in prisons, despite it being a therapeutic option widespread outside prisons 32. This service discrepancy between the community and incarcerated population contradicts, as it has already been stated, the WHO and the EU recommendations, and is both ethic and therapeutically hardly legitimate. Quality healthcare must provide a series of services which include all therapeutic options regarded by the scientific community. SUBSTANCES COMMONLY USED IN OAT: MT AND BUPRENORPHINE OR B/N. OATs have mainly used MT as opioid agonist because it is the substance with more therapeutic experience, although an estimate portrays that 25% of the cases in which it is used certain circumstances (drug interactions, pathology history, etc.) make the use of B/N more suitable 44. In October 2002, the US Food and Drug Agency (FDA) approved the use of B/N sublingual tablets in OATs excluding traditional programs 45. B/N is prescribed in the US by general physicians without any sort of additional training 46. Moreover, B/N has been successfully used in harm control programs in New York City, aimed at handling withdrawal amongst marginalized population 47. In the EU, healthcare authorities approved its use for opioid-dependence treatment in Two years later, it was commercially distributed in Spain with the same aim and it is included in the Social Security s pharmaceutical provision 48. In France, MT and buprenorphine have been used in OAT programs since 1996, but currently 60% of all patients have been prescribed buprenorphine treatment The review by Auriacombe et al 50 describes how its use became widespread. In 1995, the French Drug Agency approved its use and its commercial distribution started in February General physicians could prescribe buprenorphine, while only doctors working in clinics authorized to provide drug abuse treatment could prescribe MT. The easier use of buprenorphine, along with its complete economic reimburse due to the fact that opioid-dependence is considered a chronic disease, resulted in 10 times more opioid-dependent patients being treated with buprenorphine than with MT. From 1995 to 1999, OAT programs (80% with buprenorphine, 20% with MT) increased by 95%, while death incidence caused by overdose decreased by 79%. During this same period, death risk attributed to MT treatment was 10 times higher than the one attributed to the use of buprenorphine. Despite the fact that 20% of buprenorphine stock ended up in the illegal market, there were only rare overdose cases, usually related to sedative 107

4 36 Rev Esp Sanid Penit 2013; 15: consumption. Moreover, buprenorphine is also used in France to treat opioid-dependent pregnant women, resulting in withdrawal syndromes amongst neonates which are less frequent, less severe and shorter than those reported amongst infants whose mothers where subject to MT therapy 50. Other European countries, such as Sweden, Finland, the Czech Republic and Latvia feature more OAT programs with buprenorphine. Nevertheless, its use in Spain is less extended. In our country, the Patient Care Quality survey, by means of which 91 doctors (16 of them within the prison healthcare services) who attended opioid-dependent patients were interviewed, featured that 100% of interviewees considered availability of all treatment modalities of vital importance, in such a way that these different therapies could be used attending to patient s needs. Diversified and individual treatment availability has also been proposed as one of the courses of action by experts participating in the Treatment Systems and Drug-dependence care Lecture, set up by the Parliament (Cortes Generales) through the Joint Commission constituted to deal with Drug Issues 51. Both MT and buprenorphine feature in the WHO s essential drug list for its use in OAT. Once their efficacy has been agreed upon, it becomes important to highlight that some patients manifest predilection towards one or other treatment option. This leads to an increase in treatment compliance and adherence, and therefore to a greater efficacy 17, Full availability of drugs which have proven their efficacy in opioid-dependence therapy offers, as it has been previously stated, alternatives regarding treatment which can better attend individual needs and feature a higher possibility to adapt to patient s characteristics 58. Despite the fact that, without any doubt, MT therapy will continue to be widely implemented, there is a group of patients for which the use of B/N is the most appropriate option Use of MT and B/N in prison In France OATs with MT or with B/N can be put into practice with patients who have already initiated treatment prior to their incarceration, although before 2002 the only drug used to start OAT in prison was buprenorphine, for MT could only be prescribed by physicians specifically authorized to do so 50. In the US, in 2009, 55% of prison facilities offered OATs with MT and 14% offered treatment with buprenorphine 44. Is Spain, OAT with MT has become progressively widespread since 1992 and represents today a therapeutic option completely integrated into prison 108 healthcare. Conversely, OATs with B/N are highly limited in prisons, presumably because of economic issues, despite it being supported by the Social Security system. Nevertheless, both the European Network of Drug Services in Prison (ENDSP) and the Spanish prison policy emphasize that drugs financed by the Social Security and attainable for the general population must also be available for the incarcerated population 43. Literature concerning OATs with B/N in prisons includes some experience in the field. Thus, in a study carried out with 45 prison inmates in Puerto Rico who participated in a B/N daily program 6 months prior to their release 60, with whom the continuation of their treatment amongst the community was coordinated, the 30 days prior to incarceration were compared to the 30 days following their release. The number of days in which former inmates consumed heroin (median 30 vs 8 days; p= 0,01) and cocaine (median 2,5 vs 0 days; p=0,04), along with the number of criminal acts (p=0,06) decreased more significantly amongst patients who completed treatment. Additionally, a study carried out in a New York prison facility in 2009 which compared OAT with buprenorphine to OAT with MT, reported a higher rate of adherence to treatment during incarceration amongst patients under OAT with buprenorphine. Furthermore, patients under treatment with buprenorphine featured more continuity in treatment after their release 61. It has also been monitored that amongst patients who after their release are subject to treatment with buprenorphine, the adherence rate (38%) and the number of opioid withdrawal weeks (6,2) are similar to those amongst patients in the community who have not been imprisoned (46% and 5,9 weeks) 32,62. In Spanish prison facilities, the first B/N use experience to be acknowledged was carried out in the Albolote prison (Granada), where it was put into practice during the last detoxification phases of patients under treatment with MT 63, aimed at alleviating opioid deprivation withdrawal syndrome. MT withdrawal with B/N featured good results amongst 86% of patients (12 out of 14), a figure similar to data gathered amongst the community regarding the use of buprenorphine with the same aim Furthermore, patients manifested a high satisfaction rate and no significant adverse reactions were reported 63. DIFFERENCES BETWEEN MT AND B/N USE. There are several comparative studies confronting buprenorphine vs methadone, but their results are so-

5 Rev Esp Sanid Penit 2013; 15: metimes contradictory, for they include different doses, induction periods, etc. Originally, buprenorphine trials (without naloxone) which compared 2-16 mg doses to mg MT doses did not report any difference regarding consumption decrease and program adherence time, although they seemed to indicate the need for high buprenorphine doses to ensure success. The first clinical trial with sublingual absorbency buprenorphine was carried out by Uehlinger et al in 3 Swiss community health centers 71. It involved 58 patients selected at random who were prescribed buprenorphine (4-16mg dose/day) or MT (30-120mg/day). There were no differences between both groups as far as illegal opioid consumption decrease is concerned, but there was a higher adherence amongst MT patients, which the authors of the study attributed to the low buprenorphine doses. Suboptimal doses and slow induction have been attributed to the lower retention of buprenorphine Conversely, comparison between 65mg/day MT doses and 12mg/day buprenorphine doses portrays no difference regarding neither adherence nor illegal opioid consumption 74. Hence, buprenorphine doses play an important role as far as adherence and craving reduction are concerned. A recent meta-analysis 75 concludes that medium (8-15mg/ day) and high (over 16mg/day) buprenorphine doses are effective concerning heroin consumption reduction when compared to placebo, but is less effective than MT, especially if MT is prescribed with adequate doses between mg/day. Consequently, the authors advocate buprenorphine use mainly when high MT doses cannot be prescribed due to patient refusal or other causes, or due to a lack of MT tolerability. Additionally, other studies depict differences regarding quality of life, which seem to improve more positively amongst patients treated with B/N than amongst MT patients 76. B/N use seems also better than MT therapy as far as security is concerned, for it features lower overdose 36,50,77-79 and QT interval prolongation risks. As regards the interaction profile, B/N is globally better than MT 85 and it can be prescribed without causing withdrawal syndrome amongst HIV infected patients when combined with non-nucleoside reverse transcriptase inhibitors (NNRTI), such as efavirenz or nevirapine 86. In conclusion, B/N is a drug that features less complications than MT, clonidine or lofexidine, when aiming to achieve ambulatory detoxification 63, CONCLUSION MT and B/N are both adequate drugs for OAT. There is enough experience as far as both are concerned. Choosing one or the other depends on the opioid-dependent patient s condition and characteristics. Diversified treatment offers a treatment alternative which adapts better to the patient and can therefore improve the healthcare quality provided. B/N is an option with an efficacy similar to MT, somewhat more expensive, but safer, with a better interaction profile, less stigmatized and with the possibility of being distributed by pharmacists once patients are released, which might enhance social reintegration. Due to all this, and especially because it features in the Social Security drug provision, it should be available for patients who request it and for whom healthcare professionals consider it more suitable regarding the patient s individual characteristics, as it currently occurs outside prisons. AKNOWLEDGEMENTS We would like to thank Almudena Pardo, medical writer, for producing the initial draft and for her invaluable collaboration when writing this document. CORRESPONDENCE Dr.Antonio López Burgos Centro Penitenciario Sevilla I Crta. Mairena del Alcor, km 3, Sevilla BIBLIOGRAPHICAL REFERENCES 1. Observatorio Europeo de las Drogas y las Toxicomanías, editor. El problema de la drogodependencia en Europa. Informe anual 2009 [Internet]. Luxemburgo: Oficina de Publicaciones de la Unión Europea; 2009 [citado 06 Mar 2013]. Disponible en: system/application/views/uploads/data/portadaportadainforme2009observatorioeuropeodelasdrogasylastoxicomanias.pdf 2. Krantz MJ, Mehler PS. Treating opioid dependence. Growing implications for primary care. Arch Intern Med. 2004; 164: Tetrault JM, Fiellin DA. Current and potential pharmacological treatment options for mainte-

6 38 Rev Esp Sanid Penit 2013; 15: nance therapy in opioid-dependent individuals. Drugs. 2012; 72: Volkow ND, Wang GJ, Fowler JS, Logan J, Gatley SJ, Gifford A, et al. Prediction of reinforcing responses to psychostimulants in humans by brain dopamine D2 receptor levels. Am J Psychiatry. 1999; 156: Volkow ND, Chang L, Wang GJ, Fowler JS, Ding YS, Sedler M, et al. Low level of brain dopamine D2 receptors in methamphetamine abusers: association with metabolism in the orbitofrontal cortex. Am J Psychiatry. 2001; 158: Garavan H, Pankiewicz J, Bloom A, Cho JK, Sperry L, Ross TJ, et al. Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli. Am J Psychiatry. 2000; 157: Childress AR, Mozley PD, McElgin W, Fitzgerald J, Reivich M, O Brien CP. Limbic activation during cue-induced cocaine craving. Am J Psychiatry. 1999; 156: Volkow ND, Fowler JS, Wang GJ. The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology. 2004; 47 Suppl 1: Nurco DN, Ball JC, Shaffer JW, Hanlon TE. The criminality of narcotic addicts. J Nerv Ment Dis. 1985; 173: Centers for disease control and prevention (CDC). National center for HIV, STD and TB prevention. Prevention among Injection drug users (IDU). Substance Abuse Treatment for Injection Drug Users: A Strategy with Many Benefits. Fact Sheet series. [database on the Internet] Atlanta: CDC; 2002 [cited April 9th 2012]. Available from: 11. Soyka M, Kranzler HR, van den Brink W, Krystal J, Moller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of substance use and related disorders. Part 2: Opioid dependence. World J Biol Psychiatry. 2011; 12: WHO. Model List of Essential Medicines. [Internet]. 17th ed. Geneva: World Health Organization; 2011 [updated April 9th 2011; cited Aug. 20th 2012]. Available from: medicines/publications/essentialmedicines/en/ index.html. 13. Bennett C. Methadone maintenance treatment: disciplining the addict. Health History. 2011; 13: Hunt N, Trace M, Bewley-Tayler D. Reducing drug related harms to health: An overview of the global evidence. The Beckley Foundation Drug 110 Policy Programme. A drugscope Report. Oxford: Beckley Foundation; Hedrich D, Alves P, Farrell M, Stover H, Moller L, Mayet S. The effectiveness of opioid maintenance treatment in prison settings: a systematic review. Addiction. 2012; 107: National Institute on Drug Abuse. National Institutes of Health. Principles of drug addiction treatment. A research-based guide. In: Services NIoDANNIoHUSDoHaH, editor (2nd ed). Bethesda: National Institute on Drug Abuse. National Institutes of Health. U.S. Department of Health and Human Services; Gowing L, Farrell M, Bornemann R, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2004: CD Saiz de la Hoya P, Marco A, Garcia-Guerrero J, Rivera A, Prevalhep study group. Hepatitis C and B prevalence in Spanish prisons. Eur J Clin Microbiol Infect Dis. 2011; 30: Kastelic A, Jörg Pont J, Stöver H. Opioid Substitution Treatment in Custodial Settings. A Practical Guide. Oldenburg: BIS-Verlag der Carl von Ossietzky Universität Oldenburg; Reina E, San Miguel R, Larrea N, Garcia P, Napal V. Potential for simplification of HIV treatment with boosted protease inhibitor monotherapy. Int J Clin Pharm. 2012; 34: Martínez-Raga J, Gonzalez Saiz F, Pascual C, Casado MA, Sabater Torres FJ. Suboxone (buprenorphine/naloxone) as an agonist opioid treatment in Spain: a budgetary impact analysis. Eur Addict Res. 2010; 16: Hakansson A, Berglund M. Risk factors for criminal recidivism a prospective follow-up study in prisoners with substance abuse. BMC Psychiatry. 2012; 12: Stallwitz A, Stover H. The impact of substitution treatment in prisons a literature review. Int J Drug Policy. 2007; 18: National Health Service (NHS). The Impact of Drug Treatment on Reconviction. London: The National Treatment for Substance Misuse (NTA). National Health Service (NHS): UK, Kastelic A, Jörg Pont J, Stöver H. Opioid Substitution Treatment in Custodial Settings. A Practical Guide. Oldenburg: BIS-Verlag der Carl von Ossietzky Universität Oldenburg; Kastelic A, Kostnapfel Rihtar T. Agonist Opioid Treatment in Prisons. Heroin Addict Relat Clin Probl. 2007; 9:

7 Rev Esp Sanid Penit 2013; 15: Raftopoulos A, Flora K. Substance use related behavior of the members of Narcotics Anonymous and Alcoholics Anonymous in Greece. J Psychoactive Drugs. 2011; 43: Arroyo A, Pujol A, Carboné MT, Marrón MT, Medallo J, Puig L, et al. Drogas de abuso en detenidos en el juzgado de guardia: repercusión en el ámbito penal. Trastornos Adictivos. 2009; 11: Memoria del Plan Nacional sobre Drogas (PND) [Internet]. Madrid: Ministerio de Sanidad, Política Social e Igualdad. Secretaría General de Política Social y Consumo. Delegación del Gobierno para el Plan Nacional sobre Drogas; 2010 [citado 23 nov 2012]. Disponible en: Categoria2/publica/pdf/memo2010.pdf 30. García-Rodríguez O, Secades R, Fernández- Hermida J, Carballo J, Errasti J, Al-Halabi S. Comparación de pacientes cocainómanos y heroinómanos en el EuropASI. Adicciones. 2005; 17: Muñoz-García JJ, Navas E, Grana JL, Martínez- Arias R. Subtypes of drug-addicts in treatment: empirical support for a distinction between Type A and Type B. Psicothema. 2006; 18: Larney S, Dolan K. A literature review of international implementation of opioid substitution treatment in prisons: equivalence of care? Eur Addict Res. 2009; 15: Delegación del Gobierno para el Plan Nacional sobre Drogas. Actuar es posible. Intervención sobre drogas en centros penitenciarios[internet]. Madrid: Ministerio de Sanidad y Consumo; 2007 [citado 22 Ag. 2012]. Disponible en: Categoria2/publica/pdf/IntervCCPP.pdf 34. Estrategia Nacional sobre Drogas Plan de acción sobre drogas España [Internet]. Madrid: Ministerio de Servicos Sociales e Igualdad; 2013 [citado 22 Ag. 2012]. Disponible en: EstrategiaPNSD pdf 35. Merrall EL, Kariminia A, Binswanger IA, Hobbs MS, Farrell M, Marsden J, et al. Meta-analysis of drug-related deaths soon after release from prison. Addiction. 2010; 105: Leach D, Oliver P. Drug-related death following release from prison: a brief review of the literature with recommendations for practice. Curr Drug Abuse Rev. 2011; 4: Kerr T, Ju rgens R. Opioid Substitution Therapy in Prisons: Reviewing the Evidence [Internet]. Toronto: Canadian HIV/AIDS Legal Network; 2008 [cited 2012 July 18]; Available from: Marco A, Saíz de la Hoya P, García-Guerrero J y Grupo PREVALHEP. Estudio multicéntrico de prevalencia de infección por el VIH y factores asociados en prisiones de España. Rev Esp Sanid Penit. 2012; 14: Stover H, Michels II. Drug use and opioid substitution treatment for prisoners. Harm Reduct J. 2010; 7: WHO. Guidelines on HIV infection and AIDS in prisons [Internet]. Geneve: WHO; 1993 [cited 18th Jul 2012]. Available from: org/publications/irc-pub01/jc277-who-guidelprisons_en.pdf 41. Arroyo JM. Algunos aspectos de la sanidad penitenciaria en los países miembros de la Unión Europea. Rev Esp Sanid Penit. 2001; 3: WHO. Declaration on prison health as part of public health [Internet]. Moscow: WHO; 2003 [cited 16th Jul 2012]. Available from: euro.who.int/ data/assets/pdf_file/0007/98971/ E94242.pdf 43. Brugal MT. Papel de la Sanidad Penitenciaria en la prevención y Tratamiento del consumo de drogas ilegales (edit). Rev Esp Sanid Penit. 2012; 14: Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and buprenorphine prescribing and referral practices in US prison systems: results from a nationwide survey. Drug Alcohol Depend. 2009; 105: Amass L, Ling W, Freese TE, Reiber C, Annon JJ, Cohen AJ, et al. Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. Am J Addict. 2004; 13 (Suppl 1): S Doolittle B, Becker W. A case series of buprenorphine/naloxone treatment in a primary care practice. Subst Abus. 2011; 32: Stancliff S, Joseph H, Fong C, Furst T, Comer SD, Roux P. Opioid maintenance treatment as a harm reduction tool for opioid-dependent individuals in new york city: the need to expand access to buprenorphine/naloxone in marginalized populations. J Addict Dis. 2012; 31: Terán A. Experiencia clínica en el manejo de buprenorfina/naloxona. Rev Esp Sanid Penit. 2010; 12: Thirion X, Barrau K, Micallef J, Haramburu F, Lowenstein W, Sanmarco JL. Maintenance treatment for opioid dependence in care centers: the OPPIDUM program of the Evaluation and Information Centers for Drug Addiction. Ann Med Interne (Paris). 2000; 151 Suppl A: A10-7.

8 40 Rev Esp Sanid Penit 2013; 15: Auriacombe M, Fatseas M, Dubernet J, Daulouede JP, Tignol J. French field experience with buprenorphine. Am J Addict. 2004; 13 (Suppl 1): S Ponencia sobre Sistemas de Tratamiento y Atención en Drogodependencia de 31 de mayo de 2011 [Internet] (Boletín Oficial de las Cortes Generales Serie A: Actividades parlamentarias núm. 432 de 31/05/2011) [citado 2011 Nov 8]. Disponible en: CORT/BOCG/A/CG_A432.PDF. 52. WHO. Model List of Essential Medicines [Internet]. Geneva: World Health Organization.; 2007 [cited 27th Mar 2011]. Available from: who.int/medicines/publications/essentialmedicines/en/index.html 53. Stöver H, Hennebel LC, Casselmann J. Substitution Treatment in European Prisons. London: The European Network of Drug Services in Prison (ENDSP). Cranstoun Drug Services; Bilbao Acedos I, Lozano Rojas O, Ballesta Gómez R, González-Saiz F. Análisis cualitativo de la percepción del tratamiento con buprenorfina sublingual para la retirada del tratamiento con metadona. Trastornos Adictivos. 2009; 11: Tkacz J, Severt J, Cacciola J, Ruetsch C. Compliance with buprenorphine medication-assisted treatment and relapse to opioid use. Am J Addict. 2012; 21: Kelly SM, Brown BS, Katz EC, O Grady KE, Mitchell SG, King S, et al. A comparison of attitudes toward opioid agonist treatment among shortterm buprenorphine patients. Am J Drug Alcohol Abuse. 2012; 38: Schwarz R, Zelenev A, Bruce RD, Altice FL. Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. J Subst Abuse Treat. 2012: 43: Szerman N, Bobes J, Pérez de los Cobos J. Declaración de Socidrogalcohol, Sociedad Española de Toxicomanías (SET) y Sociedad Española de Patología Dual (SEPD) sobre las inequidades de los pacientes especiales respecto a los planes de mantenimiento con agonistas de opiáceos en la cartera de servicios comunes del Sistema Nacional de Salud. Trastornos Adictivos. 2009; 11: Baño Rodrigo D, Carreño Rendueles E, Fusté Coetzee G, Martín Carmona G, Martínez Pérez V, Martínez-Raga J, et al. Guía para el tratamiento de la adicción a opiáceos con buprenorfina/naloxona [Internet]. Barcelona: Socidrogalcohol; 2010 [citado 2011 Sept 5]. Disponible en: socidrogalcohol.org/index.php?option=com_ 112 docman&garcia CA, Correa GC, Viver AD, Kinlock TW, Gordon MS, Avila CA, et al. Buprenorphine-naloxone Treatment for Pre-release Opioid-dependent Inmates in Puerto Rico. J Addict Med. 2007; 1: Magura S, Lee JD, Hershberger J, Joseph H, Marsch L, Shropshire C, et al. Buprenorphine and methadone maintenance in jail and post-release: a randomized clinical trial. Drug Alcohol Depend. 2009; 99: Lee JD, Grossman E, Truncali A, Rotrosen J, Rosenblum A, Magura S, et al. Buprenorphinenaloxone maintenance following release from jail. Subst Abus. 2012; 33: Antón JJ. Programas de tratamiento sustitutivo con opioides en prisión. Otra alternativa a la metadona. En: Actas del XJI Congreso Internacional de Patología Dual; Octubre; Barcelona, España. 63. Antón JJ. Experiencia en el Medio Penitenciario Europeo con Terapias de Sustitución. Buprenorfina + Naloxona. Rev Esp Sanid Penit. 2010; 12: García Cabeza A, González Rodríguez A. Uso de buprenorfina en la desintoxicación del mantenimiento con metadona. Trastornos Adictivos. 2003; 5: Jonson RE, Jaffe JH, Fudala PJ. A controlled trial of buprenorphine treatment for opioid dependence. J Am Med Assoc. 1992; 267: Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Am J Psych. 1994; 151: Ling W, Wesson DR, Charuvastra C, Klett CJ. A controlled trial comparing buprenorphine and methadone maintenance in opioid dependence. Arch Gen Psych. 1996; 53: Schottenfeld RS, Pakes JR, Olivito A, Ziedonis D, Kosten TR. Buprenorphine versus methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psych. 1997; 54: Kosten TR, Schottenfeld RS, Ziedonis D, Falcioni J. Buprenorphine versus methadone maintenance for opioid dependence. J Nerv Mental Dis. 1993; 181: Uehlinguer C, Deglon JJ, Livoti S, Petijean S, Waldvogel D, Ladewin D. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Drug Alcohol Depend. 2000; 60: Krook AL, Brors O, Dahlberg J, Grouff K, Magnus P, Roysamb E, et al. A placebo controlled study

9 Rev Esp Sanid Penit 2013; 15: of high dose buprenorphine in opiate dependents waiting for medication-assisted rehabilitation in Oslo, Norway. Addiction. 2002; 97: Kakko J, Svanborg KD, Kreek MJ, Heilig M. 1-year retention and social function after buprenorphine assisted relapse prevention treatment for heroin dependence en Sweden: a randomised, placebo-controlled trial. Lancet. 2003; 361: Mattick RP, Ali R, White JM, O Brien S, Wolk S, Danz C. Buprenorphine versus methadone maintenance therapy: a randomized double blind trial with 405 opioid-dependent patients. Adicction. 2003; 98: Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: / CD002207]. 75. Maremmani I, Pani PP, Pacini M, Perugi G. Substance use and quality of life over 12 months among buprenorphine maintenance-treated and methadone maintenance-treated heroin-addicted patients. J Subst Abuse Treat. 2007; 33: Álvarez FJ. El coste del tratamiento con buprenorfina en los pacientes dependientes de opiáceos. Gastar 4 millones de euros o dejar que mueran 8 pacientes. Conductas Adictivas. 2004; 4: Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994; 55: Walsh SL, Preston KL, Bigelow GE, Stitzer ML. Acute administration of buprenorphine in humans: partial agonist and blockade effects. J Pharmacol Exp Ther. 1995; 274: Anchersen K, Clausen T, Gossop M, Hansteen V, Waal H. Prevalence and clinical relevance of corrected QT interval prolongation during methadone and buprenorphine treatment: a mortality assessment study. Addiction. 2009; 104: Thanavaro KL, Thanavaro JL. Methadone-induced torsades de pointes: A twist of fate. Heart Lung. 2011; 40: Esses JL, Rosman J, Do LT, Schweitzer P, Hanon S. Successful transition to buprenorphine in a patient with methadone-induced torsades de pointes. J Interv Card Electrophysiol. 2008; 23: Stringer J, Welsh C, Tommasello A. Methadone-associated Q-T interval prolongation and torsades de pointes. Am J Health Syst Pharm. 2009; 66: Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann Intern Med. 2009; 150: McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2009; 19: Marco A. Principales interacciones de Buprenorfina-Naloxona vs Metadona con fármacos utilizados habitualmente en los internados en prisión. Rev Esp Sanid Penit. 2010; 12: Antón JJ. Experiencia en el Medio Penitenciario Europeo con Terapias de Sustitución. Buprenorfina + Naloxona. Rev Esp Sanid Penit. 2010; 12: Itemid=19 113

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